Patients with follicular lymphoma — a form of non-Hodgkin's lymphoma — can have indolent disease and survive more than 20 years, or aggressive disease and die within 1 year of diagnosis. There is no conclusive evidence that observation, chemotherapy, haematopoietic stem-cell transplantation or immunological therapy offers any significant survival advantage. Louis Staudt and colleagues have devised a survival predictor signature for follicular lymphoma and discovered that it is the profile of the tumour-infiltrating immune cells that is most useful to guide treatment decisions.
Follicular lymphomas arise from a germinal-centre B cell that has acquired a t(14;18) translocation that deregulates the anti-apoptotic protein BCL2, but, although further oncogenic changes do occur, it is unclear how they contribute to the progression of the disease. Louis Staudt and colleagues analysed fresh-frozen tumour-biopsy specimens from 191 untreated patients who had been diagnosed with follicular lymphoma 1974–2001 at institutes in the United States and Europe. These patients had subsequently received a range of treatments and had a median follow-up of 6.6 years. The biopsy specimens were divided into a training set and a test set.
